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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 136-137

Operating Room Culture to Develop Students' Clinical Education in Iran: Hierarchical or Collaborative?

1 Department of Operative Room, Iranian Research Center on Healthy Aging, School of Paramedical, Sabzevar University of Medical Sciences, Sabzevar, Iran
2 Nursing and Midwifery Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery; Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Submission18-Sep-2019
Date of Acceptance09-Dec-2019
Date of Web Publication06-Apr-2020

Correspondence Address:
Dr. Hossein Karimi Moonaghi
School of Nursing and Midwifery, Mashhad University of Medical Sciences, Ebne-Sina Street, Mashhad, PO: 9137913199
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNMS.JNMS_44_19

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How to cite this article:
Zardosht R, Karimi Moonaghi H. Operating Room Culture to Develop Students' Clinical Education in Iran: Hierarchical or Collaborative?. J Nurs Midwifery Sci 2020;7:136-7

How to cite this URL:
Zardosht R, Karimi Moonaghi H. Operating Room Culture to Develop Students' Clinical Education in Iran: Hierarchical or Collaborative?. J Nurs Midwifery Sci [serial online] 2020 [cited 2022 Aug 12];7:136-7. Available from: https://www.jnmsjournal.org/text.asp?2020/7/2/136/281992

As part of organizational culture, operating room (OR) culture refers to a collection of shared beliefs and values that can have effects on behaviors and views of surgical team members and can be correspondingly considered as a foundation for dynamicity or a barrier to clinical education for OR students.[1] Teaching and learning processes in OR environments are also unique and more complicated than other clinical settings because many factors, including patient, teacher, student, teamwork and interdisciplinary collaboration, critical situations, as well as interactive and dynamic nature of ORs, can make a difference on the given processes among students.[2],[3] This short communication is to get a picture of OR culture in Iran.

OR, as one of the most inaccessible hospital wards, wherein physical spaces are exceptionally divided and behavior in each of these areas is different, is distinct from other units and departments. In this respect, shared cultural findings have denoted similarity of learning environments and teamwork in ORs in hierarchical, collaborative, and supportive structures.[4],[5] Some studies have described OR as a backstage in which informal behaviors of surgical team members are different compared with their formal conduct in other hospital wards, i.e., front stage.[5],[6] Surgeons' informal behaviors and insufficient experience and uncertainty in terms of tendency to teamwork make it difficult for students to understand internal integrity of teamwork.[3] Several studies in Iran have also demonstrated that OR environment culture plays a significant role in acceptance or rejection OR students in surgical teams.[7],[8]

Within a hierarchical culture, a surgeon can direct a surgical team toward accepting OR students as member of team to acquiring clinical and technical skills or rejecting them with various excuses such as slow operation progression, surgeons' haste and impatience, neglect, marginalization. Sometimes mere observation by students, described as “bitter education” and reject them.

In collaborative and supportive environments, the role of surgical team members is much more highlighted, and they can be effective as a “shadow instructor” in terms of accepting a student, creating learning opportunities, and a sense of belonging to a surgical team, by them.[3],[8]

As a whole, both hierarchical and collaborative cultures are characterized by their own strengths and weaknesses, and one does not overweigh the other. In a hierarchical culture, a surgeon is in charge of patient safety and their decisions in most cases are to the benefit of patients; although due to risks for patient life in some cases, it result is the student's separation from the surgical team. In a collaborative culture, it is also likely to have routine and nonacademic education provided by OR personnel.

Therefore, it can be concluded that making OR students familiar with OR unique culture and behaviors, teamwork, and professional communications and recruiting a competent instructor familiar with different surgical teams can play important roles in acquiring clinical competence and enhancing the quality of patient care. Further research is thus recommended in this domain to shed light on factors affecting OR culture.

Conflicts of interest

There are no conflicts of interest.

Authors' contribution

All authors contributed to this research.

The present study is financially supported by Mashhad University of Medical Sciences.


This study was supported by the Vice Chancellor for Research (VCR) at Mashhad University of Medical Sciences. We thank VCR and all of the teachers, students, and OR staff who contributed to this research despite their lack of time.

  References Top

Cameron KS, Quinn RE. Diagnosing and changing organizational culture: Based on the competing values framework. John Wiley & Sons; 2011.  Back to cited text no. 1
Farnia F, Abaszadeh A, Borhani F. Barriers to developing the nurse-patient relationship in operation room: A qualitative content analysis. JQR 2013;2:76-89.  Back to cited text no. 2
Silén-Lipponen M, Tossavainen K, Turunen H, Smith A. Learning about teamwork in operating room clinical placement. Br J Nurs 2004;13:244-53.  Back to cited text no. 3
Sigurösson HO. The meaning of being a perioperative nurse. AORN J 2001;74:202-17.  Back to cited text no. 4
Skoczylas LC, Littleton EB, Kanter SL, Sutkin G. Teaching techniques in the operating room: The importance of perceptual motor teaching. Acad Med 2012;87:364-71.  Back to cited text no. 5
Zardosht R, Moonaghi KH. Just trust me: The essential demand of operating room students. FMEJ 2018;8:3-5.  Back to cited text no. 6
Zardosht R, Moonaghi HK, Razavi ME, Ahmady S. The challenges of clinical education in a Baccalaureate Surgical Technology students in Iran: A qualitative study. E Physician 2018;10:6406-16.  Back to cited text no. 7
Moonaghi HK, Zardosht R, Razavi ME, Ahmady S. Perceived challenges by the Iranian Baccalaureate Surgical Technology students in their clinical education: A qualitative study. Biosci Biotech Res Comm 2018;10:542-50.  Back to cited text no. 8


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